Sunday, October 29, 2017

Communicate Your Way to Better Patient Satisfaction

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Image Credit: Wikimedia
Author: Bill Christian, MS-III
Ross University School of Medicine
AAEM/RSA Social Media Committee

Patient satisfaction has become more important recently for various reasons. Surveys have been developed to measure patients’ perspective of their hospital care. Such surveys ask about patients’ communication with various staff, experience in the hospital, and their overall rating.[1] While certain aspects of patient satisfaction has been studied in the past, performance on the surveys is now being coupled to insurance reimbursements, further encouraging the study of how to please patients.

Patient satisfaction is multifactorial and includes patient-, physician-, and system-related factors.[2] For example, when looking at health status as a patient-related factor, patients with poorly-controlled diabetes are less satisfied.[3] When looking at a system-related factor, such as the clinical team, one study found that aside from the physician’s care, it was the staff’s promptness, compassion, and willingness to help that were next in importance in patient satisfaction.[4] In other words, a physician might not have the best patient satisfaction if their patient has poorly-controlled diabetes and a nurse who is perceived to not have compassion or a willingness to help, despite the quality of the physician’s care. Therefore, it is important for the physician to influence patient satisfaction in areas over which he or she has control.

There are quite a few physician-related factors involved in patient satisfaction, ranging from appearance to time spent with the patient to technical skill. Communication is one method for influencing patient satisfaction that has been well studied. While the following communication strategies are not an exhaustive list, they have been shown to significantly improve patient satisfaction.
  • Address patients by their first name. Most patients want to be called by their first name, be introduced to the doctor by his or her full name and title, and see a name badge.[5]
  • Avoid interrupting the patient early in the interview. Listening is part of communication. Allowing patients to speak reduces late-arising concerns.[6]
  • Ask open-ended questions. Allowing the patient to express how her or she feels increases patient satisfaction compared to asking closed-ended questions.[7]
  • Use the word “something” rather than “anything” when eliciting concerns. For example, “Is there something else I can help you with?” is more effective without increasing the duration of the visit.[8]
  • Show lab results and explain what they mean. A study found this reduces anxiety and builds trust early in the doctor-patient relationship.[9]
  • Explain a medical condition. In doing so, it is crucial to use terminology that is appropriate to the patient’s education level.[10]
  • Express statements of empathy. Patient-perceived empathy significantly improves patient satisfaction. One can employ various techniques: naming — “it seems like you are feeling…”; understanding — “I can imagine what that would feel like”; respecting — “You have been through a lot.”[11,12]
  • Touch the patient. A social touch such as during a clinical examination and/or handshake is associated with perceived empathy, though it is important to read the interaction to ensure this will be well received.[13]
  • Smile, nod, lean in. Non-verbal cues are associated with increased patient satisfaction.[14]
Consider incorporating a few of the recommendations into your medical interview and practice. The goal is that exercising some of the aforementioned strategies can help build rapport quickly with patients you don’t know anything about other than the medical details in their charts. Implementing just a few of them may not just increase patient satisfaction, but your satisfaction as well!

1. Centers for Medicare & Medicaid Services. The HCAHPS Survey - Frequently Asked Questions. Baltimore, MD. Available at:

2. Thiedke C. What do we really know about patient satisfaction? Fam Pract Manag. 2007;14(1):33-6.

3. Redekop WK, Koopmanschap MA, Stolk RP, Rutten GE, Wolffenbuttel BH, Niessen LW. Health-related quality of life and treatment satisfaction in Dutch patients with type-2 diabetes. Diabetes Care. 2002; 25:458-63.

4. Otani K, Kurz RS, Harris LE. Managing primary care using patient satisfaction measures. J Healthc Manag. 2005; 50:311-24.

5. Lill MM, Wilkinson TJ. Judging a book by its cover. BMJ. 2005; 331:1524-7.

6. Hashim MK. Patient-centered communication: basic skills. Am Fam Physician. 2017; 95(1):29-34.

7, Ishikawa H, Takayama T, Yamazaki Y, et al. Physician-patient communication and patient satisfaction in Japanese cancer consultations. Soc Sci Med. 2002; 55(2),:301-11.

8. Heritage J, Robinson JD, Elliott MN, Beckett M, Wilkes M. Reducing patients' unmet concerns in primary care: the difference one word can make. J Gen Intern Med. 2007;22(10):1429-33.

9. Dang, B, Westbrook, R, Njue, S, Giordano T. Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC Med Educ. 2017; 17:32.

10. Kennedy DM, Caselli RJ, Berry LL. A roadmap for improving healthcare service quality. J Healthc Manag.2011; 56(6):385-400.

11. Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005; 55(3):164-77.

12. Kim, S, Kaplowitz, S. and Johnston, M. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. 2004; 27(3), pp.237-51.

13. Montague, E, Chen, P, Xu, J, Chewning,B, Barrett, B. Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy. J Particip Med. 2013; Aug 14;5:e33.

14. Griffith, C, Wilson, J, Langer, Haist, S. House staff nonverbal communication skills and standardized patient satisfaction. J Gen Intern Med. 2003 Mar;18(3)170-4.

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